Clinical survey of neurosensory side-effects of mandibular parasymphyseal bone harvesting

The aim of the present survey was to assess neurosensory disturbances and/or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal and skin sensitivity of the chin/lower lip, divided into four regions, were determined via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the mandibular teeth from the left second bicuspid to the right second bicuspid was tested by cold vitality preoperatively and 12 months postoperatively. Teeth were grouped according to sensitivity alterations and distance from the harvesting defects, as measured on CT scans, and statistically significant differences sought. At 12 months, 29% of preoperatively vital cuspids overlying the harvesting defects revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia; hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3% (5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp sensitivity changes were statistically indistinguishable regarding distances between root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity in any tooth cannot be predicted simply on the basis of the distance between its apex and the harvesting osteotomy line

Langherans' cell histiocytosis: A case report of an eosinophilic granuloma of the mandible treated with bone graft surgery and endosseous titanium implants

Eosinophilic granuloma is the localized and most benign form of Langherans' cell histiocytosis. The disease shows a particular predilection for the head and neck region and usually involves the skull bunes, where it manifests as well-defined lytic lesions on standard radiographs. The case of an extensive lesion involving the body of the mandible in a 52-year-old man is reported. Operative procedures consisted of enucleation of the lytic lesion and follow-up with clinical examinations and computerized tomographic studies of the mandible at 2, 12 and 18 months postoperatively. Reconstructive surgery without radiotherapy was performed with an autologous bone graft from the iliac crest and implant placement to provide support for a dental restoration. Key words: bone grafting, dental implants, eosinophilic granuloma, langgerhans' cell histiocytosis

Implant Success in Sinus-Lifted Maxillae and Native Bone: A 3-year Clinical and Computerized Tomographic Follow-up

Abstarct Purpose: The present study was a 3-year follow-up evaluation of implant clinical success and radiographic bone remodeling in sinus floors elevated with different autogenous bone-grafting procedures and in similar native bone regions. Materials and Methods: This retrospective chart review examined consecutive edentulous patients with severe jaw atrophy treated between 2000 and 2002 via sinus lift, when needed, and implant insertion. Implants in sinus lift areas were divided into 4 groups by graft source (iliac crest, chin area) and technique (bone block, particulate). Implants positioned in native areas beneath the sinus floor served as controls. The cumulative success rate (CSR) and success rate (SR) were calculated, and linear measurements of bone remodeling around implants were assessed on computerized tomographic scans. Results were statistically compared with the Wilcoxon signed rank test. Results: Twenty-eight patients were treated in the posterior maxilla via insertion of 70 screw-type, root-form, rough implants in 39 sinus-lifted areas. All surgical procedures were uneventful. Twenty-four implants were positioned in native areas beneath the sinus floor. The implant CSR was 95.8% in native areas (1 failure/24 implants), 85% in sinuses lifted with particulate chin bone (3 failures/ 20 implants), and 100% in the other 3 groups (8 in particulate iliac crest, 20 in chin block, 22 in iliac crest block). Computerized tomographic scans revealed that bone remodeling around apices caused implants to bulge into the sinuses in both particulate bone graft groups. Crestal remodeling around implant necks was similar for all groups. Conclusions: The use of particulate chin bone grafts in sinus lift procedures does not seem to yield optimal outcomes. Milled iliac crest and chin bone tends to remodel around the implant apices, leading to bulging within the sinuses. Grafting sinuses with either chin or iliac crest bone blocks yields the highest implant success rates and stable sinus floors. Key words: autogenous bone graft, atrophic maxilla, dental implants, osseointegration, sinus lif

Implant survival in maxillary and mandibular osseous onlay grafts and native bone: a 3-year clinical and computerized tomographic follow-up

Abstract Purpose: This article discusses a 3-year retrospective survey of implant clinical survival and computerized tomographic analysis of bone remodeling in atrophic alveolar crests reconstructed via various autogenous bone grafting procedures and in similar regions of native bone. Materials and Methods: The retrospective chart review included consecutive edentulous patients with severe alveolar crest atrophy treated between 2000 and 2002 with onlay autogenous bone grafts in the mandible and anterior maxilla (as needed) and implant insertion. Implant recipients were followed for 3 years. Defective areas were reconstructed by bone graft harvested from the chin or iliac crest. Implants in reconstructed areas were divided into 2 groups according to graft source. Implants in corresponding native areas served as controls. Cumulative survival rate (CSR), survival rate, and confidence interval (CI) were calculated, and linear measurements of bone remodeling around implants were assessed on computerized tomographic scans. Results were compared for statistically significant differences by Wilcoxon signed-rank test with a significance level a = .05. Results: Forty patients were treated with 109 screw-type, root-form, rough-surfaced implants inserted in 48 onlay grafts; 88 implants were placed in native bone. The implant 3-year CSRs were 98.9% (CI 96.7% to 100%) in native bone and 99.1% (CI 97.3% to 100%) in onlay grafts, irrespective of bone source. Mean resorption in the maxilla was 4.6 ± 0.9 mm buccally and 3.8 ± 0.8 mm palatally in areas reconstructed with chin grafts, 3.4 ± 1.7 mm buccally and 2.6 ± 1.4 mm palatally in areas reconstructed with iliac crest grafts, and 3.2 ± 1.2 mm buccally and 2.1 ± 0.9 mm palatally in native areas. Conclusions: Similar implant CSRs were seen in native and grafted sites. Maximal implant CSR was observed in onlay grafts from the chin despite more marked linear bone remodeling in this group as compared to iliac crest grafts or native bone. Key words: atrophic mandible, atrophic maxilla, autogenous bone graft, dental implants, onlay bone graft, osseointegratio

Volume changes of autogenous bone grafts after alveolar ridge augmentation of atrophic maxillae and mandibles

Abstract. The aim of the present retrospective chart review was to determine the relationship between nonvascularized osseous graft remodeling and the threedimensional (3D) features of grafts and recipient sites, the anatomical recipient regions and different graft sources. 32 iliac crest or chin grafts were onlaypositioned in the mandible or maxilla of 14 patients. CT scans, taken before implant positioning and after 1 year, revealed a mean volume resorption of 35–51%. For iliac crest grafts, the average resorption was 42% when the onlay was positioned in the anterior maxilla and 59% when it was positioned in the posterior mandible. Spearman correlation and 3D interpolation analysis revealed, for both iliac crest groups, amoderate or advanced remodeling pattern depending on3Dfeatures, namely graft thickness and shape, basal bone volume of recipient site, and the basal bone/graft volume ratio of the recipient site. No statistically significant differences were found between the recipient and donor site groups. Retrospective analysis of the data indicates that iliac crest grafts, onlay-positioned on adequate basal bone volume,may register a reduced volume remodeling when shaped thick in the anterior maxilla or rounded and convex, on the external surface, in the posterior mandible. Keywords: bone graft; bone resorption; interpolation analysis; iliac crest graft; chin graft

Clinical survey of neurosensory side-effects of mandibular parasymphyseal bone harvesting

Abstract. The aim of the present survey was to assess neurosensory disturbances and/ or tooth-pulp sensitivity losses after mandibular parasymphyseal bone-harvesting procedures. Twenty-eight harvesting areas in 16 patients were surveyed. Mucosal and skin sensitivity of the chin/lower lip, divided into four regions, were determined via Pointed-Blunt and Two-Point-Discrimination Tests. Pulp sensitivity of the mandibular teeth from the left second bicuspid to the right second bicuspid was tested by cold vitality preoperatively and 12 months postoperatively. Teeth were grouped according to sensitivity alterations and distance from the harvesting defects, as measured on CT scans, and statistically significant differences sought. At 12 months, 29% of preoperatively vital cuspids overlying the harvesting defects revealed pulp-sensitivity losses; no patient reported anaesthesia or analgesia; hypoaesthesia was present in 4% (8 sites; 2 patients), hypoalgesia was present in 3% (5 sites; 2 patients) and Two-Point-Discrimination Tests yielded pathologic responses in 5% of tested areas (10 sites; 4 patients). Teeth with and without pulp sensitivity changes were statistically indistinguishable regarding distances between root apices or mental foramen and the harvesting defect. The loss of pulp sensitivity in any tooth cannot be predicted simply on the basis of the distance between its apex and the harvesting osteotomy line. Keywords: chin bone graft; mandibular parasymphyseal bone harvesting; pulp sensitivity loss; hypoaesthesia; hypoalgesia